Department of Gastroenterology, UMC Ljubljana, University of Ljubljana, Japljeva ulica 2, 1000, Ljubljana, Slovenia.
Alimentiv Inc. (Formerly Robarts Clinical Trials Inc.), 100 Dundas Street, Suite 200, London, ON, 27N6A 5B6, Canada.
Dig Dis Sci. 2022 Feb;67(2):646-660. doi: 10.1007/s10620-021-06895-6. Epub 2021 Feb 26.
Postoperative complication rates in patients with inflammatory bowel disease (IBD) receiving preoperative biologics have been analyzed without considering the surgical context. Emergency surgery may be associated with an increased risk of infectious complications, compared to elective operations.
To conduct a systematic review and meta-analysis investigating the relationship between preoperative biologic therapy and postoperative outcomes in Crohn's disease (CD) and ulcerative colitis (UC), focusing on elective surgery.
Electronic databases were searched up to February 12, 2020, for studies of patients with IBD undergoing elective abdominal surgery receiving biologic therapy within 3 months before surgery compared to no therapy, or another biologic therapy. Certainty of evidence was evaluated using GRADE. The primary outcomes were the rate of infections and total complications within 30 days. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
Thirty-three studies were included. Preoperative treatment with anti-tumor necrosis factor (TNF) therapy in patients with CD undergoing elective surgery was associated with increased odds of infection (OR 2.05; 95% CI 1.40-3.01), but not total complications (OR 1.03; 95% CI 0.71-1.51). In elective surgery for UC, preoperative anti-TNF therapy was not associated with infectious (OR 1.03; 95% CI 0.34-3.07) or total complications (OR 0.67; 95% CI 0.29-1.58). Limited data indicate that emergency surgery did not significantly affect the rate of complications.
Anti-TNF therapy prior to elective surgery may increase the odds of postoperative infection in CD, although the certainty of evidence is very low. More evidence is needed, particularly for newer biologics.
对接受术前生物制剂治疗的炎症性肠病（IBD）患者的术后并发症发生率进行了分析，但未考虑手术背景。与择期手术相比，急诊手术可能与感染并发症的风险增加相关。
对术前生物制剂治疗与克罗恩病（CD）和溃疡性结肠炎（UC）患者择期手术术后结局之间的关系进行系统回顾和荟萃分析，重点关注择期手术。
截至 2020 年 2 月 12 日，检索电子数据库，以寻找接受生物制剂治疗的 IBD 患者择期腹部手术的研究，这些患者在手术前 3 个月内接受生物制剂治疗与未接受治疗或另一种生物制剂治疗相比。使用 GRADE 评估证据确定性。主要结局是 30 天内感染和总并发症的发生率。计算汇总优势比（OR）和 95%置信区间（CI）。
纳入 33 项研究。在接受择期手术的 CD 患者中，术前使用抗肿瘤坏死因子（TNF）治疗与感染的可能性增加相关（OR 2.05；95%CI 1.40-3.01），但与总并发症无关（OR 1.03；95%CI 0.71-1.51）。在 UC 的择期手术中，术前抗 TNF 治疗与感染（OR 1.03；95%CI 0.34-3.07）或总并发症（OR 0.67；95%CI 0.29-1.58）无关。有限的数据表明，急诊手术并未显著影响并发症发生率。
在择期手术前使用抗 TNF 治疗可能会增加 CD 术后感染的可能性，但证据的确定性非常低。需要更多的证据，特别是针对新型生物制剂。
